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The Open Group London 2014 Preview: A Conversation with RTI’s Stan Schneider about the Internet of Things and Healthcare

By The Open Group

RTI is a Silicon Valley-based messaging and communications company focused on helping to bring the Industrial Internet of Things (IoT) to fruition. Recently named “The Most Influential Industrial Internet of Things Company” by Appinions and published in Forbes, RTI’s EMEA Manager Bettina Swynnerton will be discussing the impact that the IoT and connected medical devices will have on hospital environments and the Healthcare industry at The Open Group London October 20-23. We spoke to RTI CEO Stan Schneider in advance of the event about the Industrial IoT and the areas where he sees Healthcare being impacted the most by connected devices.

Earlier this year, industry research firm Gartner declared the Internet of Things (IoT) to be the most hyped technology around, having reached the pinnacle of the firm’s famed “Hype Cycle.”

Despite the hype around consumer IoT applications—from FitBits to Nest thermostats to fashionably placed “wearables” that may begin to appear in everything from jewelry to handbags to kids’ backpacks—Stan Schneider, CEO of IoT communications platform company RTI, says that 90 percent of what we’re hearing about the IoT is not where the real value will lie. Most of media coverage and hype is about the “Consumer” IoT like Google glasses or sensors in refrigerators that tell you when the milk’s gone bad. However, most of the real value of the IoT will take place in what GE has coined as the “Industrial Internet”—applications working behind the scenes to keep industrial systems operating more efficiently, says Schneider.

“In reality, 90 percent of the real value of the IoT will be in industrial applications such as energy systems, manufacturing advances, transportation or medical systems,” Schneider says.

However, the reality today is that the IoT is quite new. As Schneider points out, most companies are still trying to figure out what their IoT strategy should be. There isn’t that much active building of real systems at this point.

Most companies, at the moment, are just trying to figure out what the Internet of Things is. I can do a webinar on ‘What is the Internet of Things?’ or ‘What is the Industrial Internet of Things?’ and get hundreds and hundreds of people showing up, most of whom don’t have any idea. That’s where most companies are. But there are several leading companies that very much have strategies, and there are a few that are even executing their strategies, ” he said. According to Schneider, these companies include GE, which he says has a 700+ person team currently dedicated to building their Industrial IoT platform, as well as companies such as Siemens and Audi, which already have some applications working.

For its part, RTI is actively involved in trying to help define how the Industrial Internet will work and how companies can take disparate devices and make them work with one another. “We’re a nuts-and-bolts, make-it-work type of company,” Schneider notes. As such, openness and standards are critical not only to RTI’s work but to the success of the Industrial IoT in general, says Schneider. RTI is currently involved in as many as 15 different industry standards initiatives.

IoT Drivers in Healthcare

Although RTI is involved in IoT initiatives in many industries, from manufacturing to the military, Healthcare is one of the company’s main areas of focus. For instance, RTI is working with GE Healthcare on the software for its CAT scanner machines. GE chose RTI’s DDS (data distribution service) product because it will let GE standardize on a single communications platform across product lines.

Schneider says there are three big drivers that are changing the medical landscape when it comes to connectivity: the evolution of standalone systems to distributed systems, the connection of devices to improve patient outcome and the replacement of dedicated wiring with networks.

The first driver is that medical devices that have been standalone devices for years are now being built on new distributed architectures. This gives practitioners and patients easier access to the technology they need.

For example, RTI customer BK Medical, a medical device manufacturer based in Denmark, is in the process of changing their ultrasound product architecture. They are moving from a single-user physical system to a wirelessly connected distributed design. Images will now be generated in and distributed by the Cloud, thus saving significant hardware costs while making the systems more accessible.

According to Schneider, ultrasound machine architecture hasn’t really changed in the last 30 or 40 years. Today’s ultrasound machines are still wheeled in on a cart. That cart contains a wired transducer, image processing hardware or software and a monitor. If someone wants to keep an image—for example images of fetuses in utero—they get carry out physical media. Years ago it was a Polaroid picture, today the images are saved to CDs and handed to the patient.

In contrast, BK’s new systems will be completely distributed, Schneider says. Doctors will be able to carry a transducer that looks more like a cellphone with them throughout the hospital. A wireless connection will upload the imaging data into the cloud for image calculation. With a distributed scenario, only one image processing system may be needed for a hospital or clinic. It can even be kept in the cloud off-site. Both patients and caregivers can access images on any display, wherever they are. This kind of architecture makes the systems much cheaper and far more efficient, Schneider says. The days of the wheeled-in cart are numbered.

The second IoT driver in Healthcare is connecting medical devices together to improve patient outcomes. Most hospital devices today are completely independent and standalone. So, if a patient is hooked up to multiple monitors, the only thing that really “connects” those devices today is a piece of paper at the end of a hospital bed that shows how each should be functioning. Nurses are supposed to check these devices on an hourly basis to make sure they’re working correctly and the patient is ok.

Schneider says this approach is error-ridden. First, the nurse may be too busy to do a good job checking the devices. Worse, any number of things can set off alarms whether there’s something wrong with the patient or not. As anyone who has ever visited a friend or relative in the hospital attest to, alarms are going off constantly, making it difficult to determine when someone is really in distress. In fact, one of the biggest problems in hospital settings today, Schneider says, is a phenomenon known as “alarm fatigue.” Single devices simply can’t reliably tell if there’s some minor glitch in data or if the patient is in real trouble. Thus, 80% of all device alarms in hospitals are turned off. Meaningless alarms fatigue personnel, so they either ignore or turn off the alarms…and people can die.

To deal with this problem, new technologies are being created that will connect devices together on a network. Multiple devices can then work in tandem to really figure out when something is wrong. If the machines are networked, alarms can be set to go off only when multiple distress indicators are indicated rather than just one. For example, if oxygen levels drop on both an oxygen monitor on someone’s finger and on a respiration monitor, the alarm is much more likely a real patient problem than if only one source shows a problem. Schneider says the algorithms to fix these problems are reasonably well understood; the barrier is the lack of networking to tie all of these machines together.

The third area of change in the industrial medical Internet is the transition to networked systems from dedicated wired designs. Surgical operating rooms offer a good example. Today’s operating room is a maze of wires connecting screens, computers, and video. Videos, for instance, come from dynamic x-ray imaging systems, from ultrasound navigation probes and from tiny cameras embedded in surgical instruments. Today, these systems are connected via HDMI or other specialized cables. These cables are hard to reconfigure. Worse, they’re difficult to sterilize, Schneider says. Thus, the surgical theater is hard to configure, clean and maintain.

In the future, the mesh of special wires can be replaced by a single, high-speed networking bus. Networks make the systems easier to configure and integrate, easier to use and accessible remotely. A single, easy-to-sterilize optical network cable can replace hundreds of wires. As wireless gets faster, even that cable can be removed.

“By changing these systems from a mesh of TV-cables to a networked data bus, you really change the way the whole system is integrated,” he said. “It’s much more flexible, maintainable and sharable outside the room. Surgical systems will be fundamentally changed by the Industrial IoT.”

IoT Challenges for Healthcare

Schneider says there are numerous challenges facing the integration of the IoT into existing Healthcare systems—from technical challenges to standards and, of course, security and privacy. But one of the biggest challenges facing the industry, he believes, is plain old fear. In particular, Schneider says, there is a lot of fear within the industry of choosing the wrong path and, in effect, “walking off a cliff” if they choose the wrong direction. Getting beyond that fear and taking risks, he says, will be necessary to move the industry forward, he says.

In a practical sense, the other thing currently holding back integration is the sheer number of connected devices currently being used in medicine, he says. Manufacturers each have their own systems and obviously have a vested interest in keeping their equipment in hospitals, so many have been reluctant to develop or become standards-compliant and push interoperability forward, Schneider says.

This is, of course, not just a Healthcare issue. “We see it in every single industry we’re in. It’s a real problem,” he said.

Legacy systems are also a problematic area. “You can’t just go into a Kaiser Permanente and rip out $2 billion worth of equipment,” he says. Integrating new systems with existing technology is a process of incremental change that takes time and vested leadership, says Schneider.

Cloud Integration a Driver

Although many of these technologies are not yet very mature, Schneider believes that the fundamental industry driver is Cloud integration. In Schneider’s view, the Industrial Internet is ultimately a systems problem. As with the ultrasound machine example from BK Medical, it’s not that an existing ultrasound machine doesn’t work just fine today, Schneider says, it’s that it could work better.

“Look what you can do if you connect it to the Cloud—you can distribute it, you can make it cheaper, you can make it better, you can make it faster, you can make it more available, you can connect it to the patient at home. It’s a huge system problem. The real overwhelming striking value of the Industrial Internet really happens when you’re not just talking about the hospital but you’re talking about the Cloud and hooking up with practitioners, patients, hospitals, home care and health records. You have to be able to integrate the whole thing together to get that ultimate value. While there are many point cases that are compelling all by themselves, realizing the vision requires getting the whole system running. A truly connected system is a ways out, but it’s exciting.”

Open Standards

Schneider also says that openness is absolutely critical for these systems to ultimately work. Just as agreeing on a standard for the HTTP running on the Internet Protocol (IP) drove the Web, a new device-appropriate protocol will be necessary for the Internet of Things to work. Consensus will be necessary, he says, so that systems can talk to each other and connectivity will work. The Industrial Internet will push that out to the Cloud and beyond, he says.

“One of my favorite quotes is from IBM, he says – IBM said, ‘it’s not a new Internet, it’s a new Web.’” By that, they mean that the industry needs new, machine-centric protocols to run over the same Internet hardware and base IP protocol, Schneider said.

Schneider believes that this new web will eventually evolve to become the new architecture for most companies. However, for now, particularly in hospitals, it’s the “things” that need to be integrated into systems and overall architectures.

One example where this level of connectivity will make a huge difference, he says, is in predictive maintenance. Once a system can “sense” or predict that a machine may fail or if a part needs to be replaced, there will be a huge economic impact and cost savings. For instance, he said Siemens uses acoustic sensors to monitor the state of its wind generators. By placing sensors next to the bearings in the machine, they can literally “listen” for squeaky wheels and thus figure out whether a turbine may soon need repair. These analytics let them know when the bearing must be replaced before the turbine shuts down. Of course, the infrastructure will need to connect all of these “things” to the each other and the cloud first. So, there will need to be a lot of system level changes in architectures.

Standards, of course, will be key to getting these architectures to work together. Schneider believes standards development for the IoT will need to be tackled from both horizontal and vertical standpoint. Both generic communication standards and industry specific standards like how to integrate an operating room must evolve.

“We are a firm believer in open standards as a way to build consensus and make things actually work. It’s absolutely critical,” he said.

stan_schneiderStan Schneider is CEO at Real-Time Innovations (RTI), the Industrial Internet of Things communications platform company. RTI is the largest embedded middleware vendor and has an extensive footprint in all areas of the Industrial Internet, including Energy, Medical, Automotive, Transportation, Defense, and Industrial Control.  Stan has published over 50 papers in both academic and industry press. He speaks at events and conferences widely on topics ranging from networked medical devices for patient safety, the future of connected cars, the role of the DDS standard in the IoT, the evolution of power systems, and understanding the various IoT protocols.  Before RTI, Stan managed a large Stanford robotics laboratory, led an embedded communications software team and built data acquisition systems for automotive impact testing.  Stan completed his PhD in Electrical Engineering and Computer Science at Stanford University, and holds a BS and MS from the University of Michigan. He is a graduate of Stanford’s Advanced Management College.

 

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The Open Group Boston 2014 to Explore How New IT Trends are Empowering Improvements in Business

By The Open Group

The Open Group Boston 2014 will be held on July 21-22 and will cover the major issues and trends surrounding Boundaryless Information Flow™. Thought-leaders at the event will share their outlook on IT trends, capabilities, best practices and global interoperability, and how this will lead to improvements in responsiveness and efficiency. The event will feature presentations from representatives of prominent organizations on topics including Healthcare, Service-Oriented Architecture, Security, Risk Management and Enterprise Architecture. The Open Group Boston will also explore how cross-organizational collaboration and trends such as big data and cloud computing are helping to make enterprises more effective.

The event will consist of two days of plenaries and interactive sessions that will provide in-depth insight on how new IT trends are leading to improvements in business. Attendees will learn how industry organizations are seeking large-scale transformation and some of the paths they are taking to realize that.

The first day of the event will bring together subject matter experts in the Open Platform 3.0™, Boundaryless Information Flow™ and Enterprise Architecture spaces. The day will feature thought-leaders from organizations including Boston University, Oracle, IBM and Raytheon. One of the keynotes is from Marshall Van Alstyne, Professor at Boston University School of Management & Researcher at MIT Center for Digital Business, which reveals the secret of internet-driven marketplaces. Other content:

• The Open Group Open Platform 3.0™ focuses on new and emerging technology trends converging with each other and leading to new business models and system designs. These trends include mobility, social media, big data analytics, cloud computing and the Internet of Things.
• Cloud security and the key differences in securing cloud computing environments vs. traditional ones as well as the methods for building secure cloud computing architectures
• Big Data as a service framework as well as preparing to deliver on Big Data promises through people, process and technology
• Integrated Data Analytics and using them to improve decision outcomes

The second day of the event will have an emphasis on Healthcare, with keynotes from Joseph Kvedar, MD, Partners HealthCare, Center for Connected Health, and Connect for Health Colorado CTO, Proteus Duxbury. The day will also showcase speakers from Hewlett Packard and Blue Cross Blue Shield, multiple tracks on a wide variety of topics such as Risk and Professional Development, and Archimate® tutorials. Key learnings include:

• Improving healthcare’s information flow is a key enabler to improving healthcare outcomes and implementing efficiencies within today’s delivery models
• Identifying the current state of IT standards and future opportunities which cover the healthcare ecosystem
• How Archimate® can be used by Enterprise Architects for driving business innovation with tried and true techniques and best practices
• Security and Risk Management evolving as software applications become more accessible through APIs – which can lead to vulnerabilities and the potential need to increase security while still understanding the business value of APIs

Member meetings will also be held on Wednesday and Thursday, June 23-24.

Don’t wait, register now to participate in these conversations and networking opportunities during The Open Group Boston 2014: http://www.opengroup.org/boston2014/registration

Join us on Twitter – #ogchat #ogBOS

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Filed under ArchiMate®, Boundaryless Information Flow™, Business Architecture, Cloud/SOA, Conference, Enterprise Architecture, Enterprise Transformation, Healthcare, Information security, Open Platform 3.0, Professional Development, RISK Management, Service Oriented Architecture, Standards, Uncategorized

Improving Patient Care and Reducing Costs in Healthcare

By Jason Lee, Director of Healthcare and Security Forums, The Open Group

Recently, The Open Group Healthcare Forum hosted a tweet jam to discuss IT and Enterprise Architecture (EA) issues as they relate to two of the most persistent problems in healthcare: reducing costs and improving patient care. Below I summarize the key points that followed from a rather unique discussion. Unique how? Unique in that rather than address these issues from the perspective of “must do” priorities (including EHR implementation, transitioning to ICD-10, and meeting enhanced HIPAA security requirements), we focused on “should do” opportunities.

We asked how stakeholders in the healthcare system can employ “Boundaryless Information Flow™” and standards development through the application of EA approaches that have proven effective in other industries to add new insights and processes to reduce costs and improve quality.

Question 1: What barriers exist for collaboration among providers in healthcare, and what can be done to improve things?
• tetradian: Huge barriers of language, terminology, mindset, worldview, paradigm, hierarchy, role and much more
• jasonsleephd: Financial, organizational, structural, lack of enabling technology, cultural, educational, professional insulation
• jim_hietala: EHRs with proprietary interfaces represent a big barrier in healthcare
• Technodad: Isn’t question really what barriers exist for collaboration between providers and patients in healthcare?
• tetradian: Communication b/w patients and providers is only one (type) amongst very many
• Technodad: Agree. Debate needs to identify whose point of view the #healthcare problem is addressing.
• Dana_Gardner: Where to begin? A Tower of Babel exists on multiple levels among #healthcare ecosystems. Too complex to fix wholesale.
• EricStephens: Also, legal ramifications of sharing information may impede sharing
• efeatherston: Patient needs provider collaboration to see any true benefit (I don’t just go to one provider)
• Dana_Gardner: Improve first by identifying essential collaborative processes that have most impact, and then enable them as secure services.
• Technodad: In US at least, solutions will need to be patient-centric to span providers- Bring Your Own Wellness (BYOW™) for HC info.
• loseby: Lack of shared capabilities & interfaces between EHRs leads to providers w/o comprehensive view of patient
• EricStephens: Are incentives aligned sufficiently to encourage collaboration? + lack of technology integration.
• tetradian: Vast numbers of stakeholder-groups, many beyond medicine – e.g. pharma, university, politics, local care (esp. outside of US)
• jim_hietala: Gap in patient-centric information flow
• Technodad: I think patents will need to drive the collaboration – they have more incentive to manage info than providers.
• efeatherston: Agreed, stakeholder list could be huge
• EricStephens: High-deductible plans will drive patients (us) to own our health care experience
• Dana_Gardner: Take patient-centric approach to making #healthcare processes better: drives adoption, which drives productivity, more adoption
• jasonsleephd: Who thinks standards development and data sharing is an essential collaboration tool?
• tetradian: not always patient-centric – e.g. epidemiology /public-health is population centric – i.e. _everything_ is ‘the centre’
• jasonsleephd: How do we break through barriers to collaboration? For one thing, we need to create financial incentives to collaborate (e.g., ACOs)
• efeatherston: Agreed, the challenge is to get them to challenge (if that makes sense). Many do not question
• EricStephens: Some will deify those in a lab coat.
• efeatherston: Still do, especially older generations, cultural
• Technodad: Agree – also displaying, fusing data from different providers, labs, monitors etc.
• dianedanamac: Online collaboration, can be cost effective & promote better quality but must financially incented
• efeatherston: Good point, unless there is a benefit/incentive for provider, they may not be bothered to try
• tetradian: “must financially incented” – often other incentives work better – money can be a distraction – also who pays?

Participants identified barriers that are not atypical: financial disincentives, underpowered technology, failure to utilize existing capability, lack of motivation to collaborate. Yet all participants viewed more collaboration as key. Consensus developed around:
• The patient (and by one commenter, the population) as the main driver of collaboration, and
• The patient as the most important stakeholder at the center of information flow.

Question 2: Does implementing remote patient tele-monitoring and online collaboration drive better and more cost-effective patient care?
• EricStephens: “Hell yes” comes to mind. Why drag yourself into a dr. office when a device can send the information (w/ video)
• efeatherston: Will it? Will those with high deductible plans have ability/understanding/influence to push for it?
• EricStephens: Driving up participation could drive up efficacy
• jim_hietala: Big opportunities to improve patient care thru remote tele-monitoring
• jasonsleephd: Tele-ICUs can keep patients (and money) in remote settings while receiving quality care
• jasonsleephd: Remote monitoring of patients admitted with CHF can reduce rehospitalization w/i 6 months @connectedhealth.org
• Dana_Gardner: Yes! Pacemakers now uplink to centralized analysis centers, communicate trends back to attending doctor. Just scratches surface
• efeatherston: Amen. Do that now, monthly uplink, annual check in with doctor to discuss any trends he sees.
• tetradian: Assumes tele-monitoring options even exist – very wide range of device-capabilities, from very high to not-much, and still not common.
• tetradian: (General request to remember that there’s more to the world, and medicine, than just the US and its somewhat idiosyncratic systems?)
• efeatherston: Yes, I do find myself looking through the lens of my own experiences, forgetting the way we do things may not translate
• jasonsleephd: Amen to point about our idiosyncrasies! Still, we have to live with them, and we can do so much better with good information flow!
• Dana_Gardner: Governments should remove barriers so more remote patient tele-monitoring occurs. Need to address the malpractice risks issue.
• TerryBlevins: Absolutely. Just want the information to go to the right place!
• Technodad: . Isn’t “right place” someplace you & all your providers can access? Need interoperability!
• TerryBlevins: It requires interoperability yes – the info must flow to those that must know.
• Technodad: Many areas where continuous monitoring can help. Improved IoT (internet of things) sensors e.g. cardio, blood chemistry coming. http://t.co/M3xw3tNvv3
• tetradian: Ethical/privacy concerns re how/with-whom that data is shared – e.g. with pharma, research, epidemiology etc
• efeatherston: Add employers to that etc. list of how/who/what is shared

Participants agreed that remote patient monitoring and telemonitoring can improve collaboration, improve patient care, and put patients more in control of their own healthcare data. However, participants expressed concerns about lack of widespread availability and the related issue of high cost. In addition, they raised important questions about who has access to these data, and they addressed nagging privacy and liability concerns.

Question 3: Can a mobile strategy improve patient experience, empowerment and satisfaction? If so, how?
• jim_hietala: mobile is a key area where patient health information can be developed/captured
• EricStephens: Example: link blood sugar monitor to iPhone to MyFitnessPal + gamification to drive adherence (and drive $$ down?)
• efeatherston: Mobile along with #InternetOfThings, wearables linked to mobile. Contact lens measuring blood sugar in recent article as ex.
• TerryBlevins: Sick people, or people getting sick are on the move. In a patient centric world we must match need.
• EricStephens: Mobile becomes a great data acquisition point. Something as simple as SMS can drive adherence with complication drug treatments
• jasonsleephd: mHealth is a very important area for innovation, better collaboration, $ reduction & quality improvement. Google recent “Webby Awards & handheld devices”
• tetradian: Mobile can help – e.g. use of SMS for medicine in Africa etc
• Technodad: Mobile isn’t option any more. Retail, prescription IoT, mobile network & computing make this a must-have. http://t.co/b5atiprIU9
• dianedanamac: Providers need to be able to receive the information mHealth
• Dana_Gardner: Healthcare should go location-independent. Patient is anywhere, therefore so is care, data, access. More than mobile, IMHO.
• Technodad: Technology and mobile demand will outrun regional provider systems, payers, regulation
• Dana_Gardner: As so why do they need to be regional? Cloud can enable supply-demand optimization regardless of location for much.
• TerryBlevins: And the caregivers are also on the move!
• Dana_Gardner: Also, more machine-driven care, i.e. IBM Watson, for managing the routing and prioritization. Helps mitigate overload.
• Technodad: Agree – more on that later!
• Technodad: Regional providers are the reality in the US. Would love to have more national/global coverage.
• Dana_Gardner: Yes, let the market work its magic by making it a larger market, when information is the key.
• tetradian: “let the market do its work” – ‘the market’ is probably the quickest way to destroy trust! – not a good idea…
• Technodad: To me, problem is coordinating among multi providers, labs etc. My health info seems to move at glacial pace then.
• tetradian: “Regional providers are the reality in the US.” – people move around: get info follow them is _hard_ (1st-hand exp. there…)
• tetradian: danger of hype/fear-driven apps – may need regulation, or at least regulatory monitoring
• jasonsleephd: Regulators, as in FDA or something similar?
• tetradian: “Regulators as in FDA” etc – at least oversight of that kind, yes (cf. vitamins, supplements, health-advice services)
• jim_hietala: mobile, consumer health device innovation moving much faster than IT ability to absorb
• tetradian: also beware of IT-centrism and culture – my 90yr-old mother has a cell-phone, but has almost no idea how to use it!
• Dana_Gardner: Information and rely of next steps (in prevention or acute care) are key, and can be mobile. Bring care to the patient ASAP.

Participants began in full agreement. Mobile health is not even an option but a “given” now. Recognition that provider ability to receive information is lacking. Cloud viewed as means to overcome regionalization of data storage problems. When the discussion turned to further development of mHealth there was some debate on what can be left to the market and whether some form of regulatory action is needed.

Question 4: Does better information flow and availability in healthcare reduce operation cost, and free up resources for more patient care?
• tetradian: A4: should do, but it’s _way_ more complex than most IT-folks seem to expect or understand (e.g. repeated health-IT fails in UK)
• jim_hietala: A4: removing barriers to health info flow may reduce costs, but for me it’s mostly about opportunity to improve patient care
• jasonsleephd: Absolutely. Consider claims processing alone. Admin costs in private health ins. are 20% or more. In Medicare less than 2%.
• loseby: Absolutely! ACO model is proving it. Better information flow and availability also significantly reduces hospital admissions
• dianedanamac: I love it when the MD can access my x-rays and lab results so we have more time.
• efeatherston: I love it when the MD can access my x-rays and lab results so we have more time.
• EricStephens: More info flow + availability -> less admin staff -> more med staff.
• EricStephens: Get the right info to the ER Dr. can save a life by avoiding contraindicated medicines
• jasonsleephd: EricStephens GO CPOE!!
• TerryBlevins: @theopengroup. believe so, but ask the providers. My doctor is more focused on patient by using simple tech to improve info flow
• tetradian: don’t forget link b/w information-flows and trust – if trust fails, so does the information-flow – worse than where we started!
• jasonsleephd: Yes! Trust is really key to this conversation!
• EricStephens: processing a claim, in most cases, should be no more difficult than an expense report or online order. Real-time adjudication
• TerryBlevins: Great point.
• efeatherston: Agreed should be, would love to see it happen. Trust in the data as mentioned earlier is key (and the process)
• tetradian: A4: sharing b/w patient and MD is core, yes, but who else needs to access that data – or _not_ see it? #privacy
• TerryBlevins: A4: @theopengroup can’t forget that if info doesn’t flow sometimes the consequences are fatal, so unblocked the flow.
• tetradian: .@TerryBlevins A4: “if info doesn’t flow sometimes the consequences are fatal,” – v.important!
• Technodad: . @tetradian To me, problem is coordinating among multi providers, labs etc. My health info seems to move at glacial pace then.
• TerryBlevins: A4: @Technodad @tetradian I have heard that a patient moving on a gurney moves faster than the info in a hospital.
• Dana_Gardner: A4 Better info flow in #healthcare like web access has helped. Now needs to go further to be interactive, responsive, predictive.
• jim_hietala: A4: how about pricing info flow in healthcare, which is almost totally lacking
• Dana_Gardner: A4 #BigData, #cloud, machine learning can make 1st points of #healthcare contact a tech interface. Not sci-fi, but not here either.

Starting with the recognition that this is a very complicated issue, the conversation quickly produced a consensus view that mobile health is key, both to cost reduction and quality improvement and increased patient satisfaction. Trust that information is accurate, available and used to support trust in the provider-patient relationship emerged as a relevant issue. Then, naturally, privacy issues surfaced. Coordination of information flow and lack of interoperability were recognized as important barriers and the conversation finally turned somewhat abstract and technical with mentions of big data and the cloud and pricing information flows without much in the way of specifying how to connect the dots.

Question 5: Do you think payers and providers are placing enough focus on using technology to positively impact patient satisfaction?
• Technodad: A5: I think there are positive signs but good architecture is lacking. Current course will end w/ provider information stovepipes.
• TerryBlevins: A5: @theopengroup Providers are doing more. I think much more is needed for payers – they actually may be worse.
• theopengroup: @TerryBlevins Interesting – where do you see opportunities for improvements with payers?
• TerryBlevins: A5: @theopengroup like was said below claims processing – an onerous job for providers and patients – mostly info issue.
• tetradian: A5: “enough focus on using tech”? – no, not yet – but probably won’t until tech folks properly face the non-tech issues…
• EricStephens: A5 No. I’m not sure patient satisfaction (customer experience/CX?) is even a factor sometimes. Patients not treated like customers
• dianedanamac: .@EricStephens SO TRUE! Patients not treated like customers
• Technodad: . @EricStephens Amen to that. Stovepipe data in provider systems is barrier to understanding my health & therefore satisfaction.
• dianedanamac: “@mclark497: @EricStephens issue is the customer is treat as only 1 dimension. There is also the family experience to consider too
• tetradian: .@EricStephens A5: “Patients not treated like customers” – who _is_ ‘the customer’? – that’s a really tricky question…
• efeatherston: @tetradian @EricStephens Trickiest question. to the provider is the patient or the payer the customer?
• tetradian: .@efeatherston “patient or payer” – yeah, though it gets _way_ more complex than that once we explore real stakeholder-relations
• efeatherston: @tetradian So true.
• jasonsleephd: .@tetradian @efeatherston Very true. There are so many diff stakeholders. But to align payers and pts would be huge
• efeatherston: @jasonsleephd @tetradian re: aligning payers and patients, agree, it would be huge and a good thing
• jasonsleephd: .@efeatherston @tetradian @EricStephens Ideally, there should be no dividing line between the payer and the patient!
• efeatherston: @jasonsleephd @tetradian @EricStephens Ideally I agree, and long for that ideal world.
• EricStephens: .@jasonsleephd @efeatherston @tetradian the payer s/b a financial proxy for the patient. and nothing more
• TerryBlevins: @EricStephens @jasonsleephd @efeatherston @tetradian … got a LOL out of me.
• Technodad: . @tetradian @EricStephens That’s a case of distorted marketplace. #Healthcare architecture must cut through to patient.
• tetradian: .@Technodad “That’s a case of distorted marketplace.” – yep. now add in the politics of consultants and their hierarchies, etc?
• TerryBlevins: A5: @efeatherston @tetradian @EricStephens in patient cetric world it is the patient and or their proxy.
• jasonsleephd: A5: Not enough emphasis on how proven technologies and architectural structures in other industries can benefit healthcare
• jim_hietala: A5: distinct tension in healthcare between patient-focus and meeting mandates (a US issue)
• tetradian: .@jim_hietala A5: “meeting mandates (a US issue)” – UK NHS (national-health-service) may be even worse than US – a mess of ‘targets’
• EricStephens: A5 @jim_hietala …and avoiding lawsuits
• tetradian: A5: most IT-type tech still not well-suited to the level of mass-uniqueness inherent in the healthcare context
• Dana_Gardner: A5 They are using tech, but patient “satisfaction” not yet a top driver. We have a long ways to go on that. But it can help a ton.
• theopengroup: @Dana_Gardner Agree, there’s a long way to go. What would you say is the starting point for providers to tie the two together?
• Dana_Gardner: @theopengroup An incentive other than to avoid lawsuits. A transparent care ratings capability. Outcomes focus based on total health
• Technodad: A5: I’d be satisfied just to not have to enter my patient info & history on a clipboard in every different provider I go to!
• dianedanamac: A5 @tetradian Better data sharing & Collab. less redundancy, lower cost, more focus on patient needs -all possible w/ technology
• Technodad: A5: The patient/payer discussion is a red herring. If the patient weren’t there, rest of the system would be unnecessary.
• jim_hietala: RT @Technodad: The patient/payer discussion is a red herring. If the patient weren’t there, rest of system unnecessary. AMEN

Very interesting conversation. Positive signs of progress were noted but so too were indications that healthcare will remain far behind the technology curve in the foreseeable future. Providers were given higher “grades” than payers. Yet, claims processing would seemingly be one of the easiest areas for technology-assisted improvement. One discussant noted that there will not be enough focus on technology in healthcare “until the tech folks properly face the non-tech issues”. This would seem to open a wide door for EA experts to enter the healthcare domain! The barriers (and opportunities) to this may be the topic of another tweet jam, or Open Group White Paper.
Interestingly, part way into the discussion the topic turned to the lack of a real customer/patient focus in healthcare. Not enough emphasis on patient satisfaction. Not enough attention to patient outcomes. There needs to be a better/closer alignment between what motivates payers and the needs of patients.

Question 6: As some have pointed out, many of the EHR systems are highly proprietary, how can standards deliver benefits in healthcare?
• jim_hietala: A6: Standards will help by lowering the barriers to capturing data, esp. for mhealth, and getting it to point of care
• tetradian: .@jim_hietala “esp. for mhealth” – focus on mhealth may be a way to break the proprietary logjam, ‘cos it ain’t proprietary yet
• TerryBlevins: A6: @theopengroup So now I deal with at least 3 different EHR systems. All requiring me to be the info steward! Hmmm
• TerryBlevins: A6 @theopengroup following up if they shared data through standards maybe they can synchronize.
• EricStephens: A6 – Standards lead to better interoperability, increased viscosity of information which will lead to lowers costs, better outcomes.
• efeatherston: @EricStephens and greater trust in the info (as was mentioned earlier, trust in the information key to success)
• jasonsleephd: A6: Standards development will not kill innovation but rather make proprietary systems interoperable
• Technodad: A6: Metcalfe’s law rules! HC’s many providers-many patients structure means interop systems will be > cost effective in long run.
• tetradian: A6: the politics of this are _huge_, likewise the complexities – if we don’t face those issues right up-front, this is going nowhere

On his April 24, 2014 post at www.weblog.tetradian.com, Tom Graves provided a clearly stated position on the role of The Open Group in delivering standards to help healthcare improve. He wrote:

“To me, this is where The Open Group has an obvious place and a much-needed role, because it’s more than just an IT-standards body. The Open Group membership are mostly IT-type organisations, yes, which tends to guide towards IT-standards, and that’s unquestionably of importance here. Yet perhaps the real role for The Open Group as an organisation is in its capabilities and experience in building consortia across whole industries: EMMM™ and FACE are two that come immediately to mind. Given the maze of stakeholders and the minefields of vested-interests across the health-context, those consortia-building skills and experience are perhaps what’s most needed here.”

The Open Group is the ideal organization to engage in this work. There are many ways to collaborate. You can join The Open Group Healthcare Forum, follow the Forum on Twitter @ogHealthcare and connect on The Open Group Healthcare Forum LinkedIn Group.

Jason Lee headshotJason Lee, Director of Healthcare and Security Forums at The Open Group, has conducted healthcare research, policy analysis and consulting for over 20 years. He is a nationally recognized expert in healthcare organization, finance and delivery and applies his expertise to a wide range of issues, including healthcare quality, value-based healthcare, and patient-centered outcomes research. Jason worked for the legislative branch of the U.S. Congress from 1990-2000 — first at GAO, then at CRS, then as Health Policy Counsel for the Chairman of the House Energy and Commerce Committee (in which role the National Journal named him a “Top Congressional Aide” and he was profiled in the Almanac of the Unelected). Subsequently, Jason held roles of increasing responsibility with non-profit organizations — including AcademyHealth, NORC, NIHCM, and NEHI. Jason has published quantitative and qualitative findings in Health Affairs and other journals and his work has been quoted in Newsweek, the Wall Street Journal and a host of trade publications. He is a Fellow of the Employee Benefit Research Institute, was an adjunct faculty member at the George Washington University, and has served on several boards. Jason earned a Ph.D. in social psychology from the University of Michigan and completed two postdoctoral programs (supported by the National Science Foundation and the National Institutes of Health). He is the proud father of twins and lives outside of Boston.

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Improving Patient Care and Reducing Costs in Healthcare – Join The Open Group Tweet Jam on Wednesday, April 23

By Jason Lee, Director of Healthcare and Security Forums, The Open Group

On Wednesday, April 23 at 9:00 am PT/12:00 pm ET/5:00 pm GMT, The Open Group Healthcare Forum will host a tweet jam to discuss the issues around healthcare and improving patient care while reducing costs. Many healthcare payer and provider organizations today are facing numerous “must do” priorities, including EHR implementation, transitioning to ICD-10, and meeting enhanced HIPAA security requirements.

This tweet jam will focus on opportunities that healthcare organizations have available to improve patient care and reduce costs associated with capturing, maintaining, and sharing patient information. It will also explore how using Enterprise Architectural approaches that have proven effective in other industries will apply to the healthcare sector and dramatically improve both costs and patient care.

In addition to the need for implementing integrated digital health records that can be shared across health organizations to maximize care for both patients who don’t want to repeat themselves and the doctors providing their care, we’ll explore what other solutions exist to enhance information flow. For example, did you know that a new social network for M.D.s has even emerged to connect and communicate across teams, hospitals and entire health systems? The new network, called Doximity, boasts that 40 percent of U.S. doctors have signed on. Not only are doctors using social media, they’re using software specifically designed for the iPad that roughly 68 percent of doctors are carrying around. One hospital even calculated its return on investment of utilizing a an iPad in just nine days!

We’ll be talking about how many healthcare thought leaders are looking at technology and its influence on online collaboration, patient telemonitoring and information flow.

We welcome The Open Group members and interested participants from all backgrounds to join the discussion and interact with our panel of thought-leaders including Jim Hietala, Vice President of Security; David Lounsbury, CTO; and Dr. Chris Harding, Forum Director of Open Platform 3.0™ Forum. To access the discussion, please follow the hashtag #ogchat during the allotted discussion time.

Interested in joining The Open Group Healthcare Forum? Register your interest, here.

What Is a Tweet Jam?

The Open Group tweet jam, approximately 45 minutes in length, is a “discussion” hosted on Twitter. The purpose of the tweet jam is to share knowledge and answer questions on relevant and thought-provoking issues. Each tweet jam is led by a moderator and a dedicated group of experts to keep the discussion flowing. The public (or anyone using Twitter interested in the topic) is encouraged to join the discussion.

Participation Guidance

Whether you’re a newbie or veteran Twitter user, here are a few tips to keep in mind:

Have your first #ogchat tweet be a self-introduction: name, affiliation, occupation.

Start all other tweets with the question number you’re responding to and add the #ogchat hashtag.

Sample: Q1 What barriers exist for collaboration among providers in healthcare, and what can be done to improve things? #ogchat

Please refrain from product or service promotions. The goal of a tweet jam is to encourage an exchange of knowledge and stimulate discussion.

While this is a professional get-together, we don’t have to be stiff! Informality will not be an issue.

A tweet jam is akin to a public forum, panel discussion or Town Hall meeting – let’s be focused and thoughtful.

If you have any questions prior to the event or would like to join as a participant, please contact Rob Checkal (@robcheckal or rob.checkal@hotwirepr.com). We anticipate a lively chat and hope you will be able to join!

Jason Lee headshotJason Lee, Director of Healthcare and Security Forums at The Open Group, has conducted healthcare research, policy analysis and consulting for over 20 years. He is a nationally recognized expert in healthcare organization, finance and delivery and applies his expertise to a wide range of issues, including healthcare quality, value-based healthcare, and patient-centered outcomes research. Jason worked for the legislative branch of the U.S. Congress from 1990-2000 — first at GAO, then at CRS, then as Health Policy Counsel for the Chairman of the House Energy and Commerce Committee (in which role the National Journal named him a “Top Congressional Aide” and he was profiled in the Almanac of the Unelected). Subsequently, Jason held roles of increasing responsibility with non-profit organizations — including AcademyHealth, NORC, NIHCM, and NEHI. Jason has published quantitative and qualitative findings in Health Affairs and other journals and his work has been quoted in Newsweek, the Wall Street Journal and a host of trade publications. He is a Fellow of the Employee Benefit Research Institute, was an adjunct faculty member at the George Washington University, and has served on several boards. Jason earned a Ph.D. in social psychology from the University of Michigan and completed two postdoctoral programs (supported by the National Science Foundation and the National Institutes of Health). He is the proud father of twins and lives outside of Boston.

 

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The Financial Incentive for Health Information Exchanges

By Jim Hietala, VP, Security, The Open Group

Health IT professionals have always known that interoperability would be one of the most important aspects of the Affordable Care Act (ACA). Now doctors have financial incentive to be proactive in taking part in the process of exchange information between computer systems.

According to a recent article in MedPage Today, doctors are now “clamoring” for access to patient information ahead of the deadlines for the government’s “meaningful use” program. Doctors and hospitals will get hit with fines for not knowing about patients’ health histories, for patient readmissions and unnecessary retesting. “Meaningful use” refers to provisions in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use electronic health records in a meaningful way that significantly improves clinical care.
Doctors who accept Medicare will find themselves penalized for not adopting or successfully demonstrating meaningful use of a certified electronic health record (EHR) technology by 2015. Health professionals’ Medicare physician fee schedule amount for covered professional services will be adjusted down by 1% each year for certain categories.  If less than 75% of Eligible Professionals (EPs) have become meaningful users of EHRs by 2018, the adjustment will change by 1% point each year to a maximum of 5% (95% of Medicare covered amount).

With the stick, there’s also a carrot. The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.

According to HealthIT.Gov, interoperability is essential for applications that interact with users (such as e-prescribing), systems that communicate with each other (such as messaging standards) information processes and management (such as health information exchange) how consumer devices integrate with other systems and applications (such as tablet, smart phones and PCs).

The good news is that more and more hospitals and doctors are participating in data exchanges and sharing patient information. On January 30th, the eHealth Exchange, formerly the Nationwide Health Information Network, and operated by Healtheway, reported a surge in network participation numbers and increases in secure online transactions among members.

According to the news release, membership in the eHealth Exchange is currently pegged at 41 participants who together represent some 800 hospitals, 6,000 mid-to-large medical groups, 800 dialysis centers and 850 retail pharmacies nationwide. Some of the earliest members to sign on with the exchange were the Veterans Health Administration, Department of Defense, Kaiser Permanente, the Social Security Administration and Dignity Health.

While the progress in health information exchanges is good, there is still much work to do in defining standards, so that the right information is available at the right time and place to enable better patient care. Devices are emerging that can capture continuous information on our health status. The information captured by these devices can enable better outcomes, but only if the information is made readily available to medical professionals.

The Open Group recently formed The Open Group Healthcare Forum, which focuses on bringing  Boundaryless Information Flow™ to the healthcare industry enabling data to flow more easily throughout the complete healthcare ecosystem.  By leveraging the discipline and principles of Enterprise Architecture, including TOGAF®, an Open Group standard, the forum aims to develop standardized vocabulary and messaging that will result in higher quality outcomes, streamlined business practices and innovation within the industry.

62940-hietalaJim Hietala, CISSP, GSEC, is the Vice President, Security for The Open Group, where he manages all IT security, risk management and healthcare programs and standards activities. He participates in the SANS Analyst/Expert program and has also published numerous articles on information security, risk management, and compliance topics in publications including The ISSA Journal, Bank Accounting & Finance, Risk Factor, SC Magazine, and others.

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Facing the Challenges of the Healthcare Industry – An Interview with Eric Stephens of The Open Group Healthcare Forum

By The Open Group

The Open Group launched its new Healthcare Forum at the Philadelphia conference in July 2013. The forum’s focus is on bringing Boundaryless Information Flow™ to the healthcare industry to enable data to flow more easily throughout the complete healthcare ecosystem through a standardized vocabulary and messaging. Leveraging the discipline and principles of Enterprise Architecture, including TOGAF®, the forum aims to develop standards that will result in higher quality outcomes, streamlined business practices and innovation within the industry.

At the recent San Francisco 2014 conference, Eric Stephens, Enterprise Architect at Oracle, delivered a keynote address entitled, “Enabling the Opportunity to Achieve Boundaryless Information Flow” along with Larry Schmidt, HP Fellow at Hewlett-Packard. A veteran of the healthcare industry, Stephens was Senior Director of Enterprise Architects Excellus for BlueCross BlueShield prior to joining Oracle and he is an active member of the Healthcare Forum.

We sat down after the keynote to speak with Stephens about the challenges of healthcare, how standards can help realign the industry and the goals of the forum. The opinions expressed here are Stephens’ own, not of his employer.

What are some of the challenges currently facing the healthcare industry?

There are a number of challenges, and I think when we look at it as a U.S.-centric problem, there’s a disproportionate amount of spending that’s taking place in the U.S. For example, if you look at GDP or percentage of GDP expenditures, we’re looking at now probably 18 percent of GDP [in the U.S.], and other developed countries are spending a full 5 percent less than that of their GDP, and in some cases they’re getting better outcomes outside the U.S.

The mere fact that there’s the existence of what we call “medical tourism, where if I need a hip replacement, I can get it done for a fraction of the cost in another country, same or better quality care and have a vacation—a rehab vacation—at the same time and bring along a spouse or significant other, means there’s a real wide range of disparity there. 

There’s also a lack of transparency. Having worked at an insurance company, I can tell you that with the advent of high deductible plans, there’s a need for additional cost information. When I go on Amazon or go to a local furniture store, I know what the cost is going to be for what I’m about to purchase. In the healthcare system, we don’t get that. With high deductible plans, if I’m going to be responsible for a portion or a larger portion of the fee, I want to know what it is. And what happens is, the incentives to drive costs down force the patient to be a consumer. The consumer now asks the tough questions. If my daughter’s going in for a tonsillectomy, show me a bill of materials that shows me what’s going to be done – if you are charging me $20/pill for Tylenol, I’ll bring my own. Increased transparency is what will in turn drive down the overall costs.

I think there’s one more thing, and this gets into the legal side of things. There is an exorbitant amount of legislation and regulation around what needs to be done. And because every time something goes sideways, there’s going to be a lawsuit, doctors will prescribe an extra test, and extra X-ray for a patient whether they need it or not.

The healthcare system is designed around a vicious cycle of diagnose-treat-release. It’s not incentivized to focus on prevention and management. Oregon is promoting these coordinated care organizations (CCOs) that would be this intermediary that works with all medical professionals – whether it was physical, mental, dental, even social worker – to coordinate episodes of care for patients. This drives down inappropriate utilization – for example, using an ER as a primary care facility and drives the medical system towards prevention and management of health. 

Your keynote with Larry Schmidt of HP focused a lot on cultural changes that need to take place within the healthcare industry – what are some of the changes necessary for the healthcare industry to put standards into place?

I would say culturally, it goes back to those incentives, and it goes back to introducing this idea of patient-centricity. And for the medical community, to really start recognizing that these individuals are consumers and increased choice is being introduced, just like you see in other industries. There are disruptive business models. As a for instance, medical tourism is a disruptive business model for United States-based healthcare. The idea of pharmacies introducing clinical medicine for routine care, such as what you see at a CVS, Wal-Mart or Walgreens. I can get a flu shot, I can get a well-check visit, I can get a vaccine – routine stuff that doesn’t warrant a full-blown medical professional. It’s applying the right amount of medical care to a particular situation.

Why haven’t existing standards been adopted more broadly within the industry? What will help providers be more likely to adopt standards?

I think the standards adoption is about “what’s in it for me, the WIIFM idea. It’s demonstrating to providers that utilizing standards is going to help them get out of the medical administration business and focus on their core business, the same way that any other business would want to standardize its information through integration, processes and components. It reduces your overall maintenance costs going forward and arguably you don’t need a team of billing folks sitting in an doctor’s office because you have standardized exchanges of information.

Why haven’t they been adopted? It’s still a question in my mind. Why would a doctor not want to do that is perhaps a question we’re going to need to explore as part of the Healthcare Forum.

Is it doctors that need to adopt the standards or technologies or combination of different constituents within the ecosystem?

I think it’s a combination. We hear a lot about the Affordable Care Act (ACA) and the health exchanges. What we don’t hear about is the legislation to drive toward standardization to increase interoperability. So unfortunately it would seem the financial incentives or things we’ve tried before haven’t worked, and we may simply have to resort to legislation or at least legislative incentives to make it happen because part of the funding does cover information exchanges so you can move health information between providers and other actors in the healthcare system.

You’re advocating putting the individual at the center of the healthcare ecosystem. What changes need to take place within the industry in order to do this?

I think it’s education, a lot of education that has to take place. I think that individuals via the incentive model around high deductible plans will force some of that but it’s taking responsibility and understanding the individual role in healthcare. It’s also a cultural/societal phenomenon.

I’m kind of speculating here, and going way beyond what enterprise architecture or what IT would deliver, but this is a philosophical thing around if I have an ailment, chances are there’s a pill to fix it. Look at the commercials, every ailment say hypertension, it’s easy, you just dial the medication correctly and you don’t worry as much about diet and exercise. These sorts of things – our over-reliance on medication. I’m certainly not going to knock the medications that are needed for folks that absolutely need them – but I think we can become too dependent on pharmacological solutions for our health problems.   

What responsibility will individuals then have for their healthcare? Will that also require a cultural and behavioral shift for the individual?

The individual has to start managing his or her own health. We manage our careers and families proactively. Now we need to focus on our health and not just float through the system. It may come to financial incentives for certain “individual KPIs such as blood pressure, sugar levels, or BMI. Advances in medical technology may facilitate more personal management of one’s health.

One of the Healthcare Forum’s goals is to help establish Boundaryless Information Flow within the Healthcare industry you’ve said that understanding the healthcare ecosystem will be a key component for that what does that ecosystem encompass and why is it important to know that first?

Very simply we’re talking about the member/patient/consumer, then we get into the payers, the providers, and we have to take into account government agencies and other non-medical agents, but they all have to work in concert and information needs to flow between those organizations in a very standardized way so that decisions can be made in a very timely fashion.

It can’t be bottled up, it’s got to be provided to the right provider at the right time, otherwise, best case, it’s going to cost more to manage all the actors in the system. Worst case, somebody dies or there is a “never event due to misinformation or lack of information during the course of care. The idea of Boundaryless Information Flow gives us the opportunity to standardize, have easily accessible information – and by the way secured – it can really aide in that decision-making process going forward. It’s no different than Wal-Mart knowing what kind of merchandise sells well before and after a hurricane (i.e., beer and toaster pastries, BTW). It’s the same kind of real-time information that’s made available to a Google car so it can steer its way down the road. It’s that kind of viscosity needed to make the right decisions at the right time.

Healthcare is a highly regulated industry, how can Boundarylesss Information Flow and data collection on individuals be achieved and still protect patient privacy?

We can talk about standards and the flow and the technical side. We need to focus on the security and privacy side.  And there’s going to be a legislative side because we’re going to touch on real fundamental data governance issue – who owns the patient record? Each actor in the system thinks they own the patient record. If we’re going to require more personal accountability for healthcare, then shouldn’t the consumer have more ownership? 

We also need to address privacy disclosure regulations to avoid catastrophic data leaks of protected health information (PHI). We need bright IT talent to pull off the integration we are talking about here. We also need folks who are well versed in the privacy laws and regulations. I’ve seen project teams of 200 have up to eight folks just focusing on the security and privacy considerations. We can argue about headcount later but my point is the same – one needs some focused resources around this topic.

What will standards bring to the healthcare industry that is missing now?

I think the standards, and more specifically the harmonization of the standards, is going to bring increased maintainability of solutions, I think it’s going to bring increased interoperability, I think it’s going to bring increased opportunities too. We see mobile computing or even DropBox, that has API hooks into all sorts of tools, and it’s well integrated – so I can integrate and I can move files between devices, I can move files between apps because they have hooks it’s easy to work with. So it’s building these communities of developers, apps and technical capabilities that makes it easy to move the personal health record for example, back and forth between providers and it’s not a cataclysmic event to integrate a new version of electronic health records (EHR) or to integrate the next version of an EHR. This idea of standardization but also some flexibility that goes into it.

Are you looking just at the U.S. or how do you make a standard that can go across borders and be international?

It is a concern, much of my thinking and much of what I’ve conveyed today is U.S.-centric, based on our problems, but many of these interoperability problems are international. We’re going to need to address it; I couldn’t tell you what the sequence is right now. There are other considerations, for example, single vs. multi-payer—that came up in the keynote. We tend to think that if we stay focused on the consumer/patient we’re going to get it for all constituencies. It will take time to go international with a standard, but it wouldn’t be the first time. We have a host of technical standards for the Internet (e.g., TCP/IP, HTTP). The industry has been able to instill these standards across geographies and vendors. Admittedly, the harmonization of health care-related standards will be more difficult. However, as our world shrinks with globalization an international lens will need to be applied to this challenge. 

Eric StephensEric Stephens (@EricStephens) is a member of Oracle’s executive advisory community where he focuses on advancing clients’ business initiatives leveraging the practice of Business and Enterprise Architecture. Prior to joining Oracle he was Senior Director of Enterprise Architecture at Excellus BlueCross BlueShield leading the organization with architecture design, innovation, and technology adoption capabilities within the healthcare industry.

 

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Gaining Dependability Across All Business Activities Requires Standard of Standards to Tame Dynamic Complexity, Says The Open Group CEO

By Dana Gardner, Interarbor Solutions

Listen to the recorded podcast here

Hello, and welcome to a special BriefingsDirect Thought Leadership

Interview series, coming to you in conjunction with The Open Group Conference on July 15, in Philadelphia.

88104-aaadanaI’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator throughout these discussions on enterprise transformation in the finance, government, and healthcare sector.

We’re here now with the President and CEO of The Open Group, Allen Brown, to explore the increasingly essential role of standards, in an undependable, unpredictable world. [Disclosure: The Open Group is a sponsor of BriefingsDirect podcasts.]

Welcome back, Allen.

Allen Brown: It’s good to be here, Dana. abrown

Gardner: What are the environmental variables that many companies are facing now as they try to improve their businesses and assess the level of risk and difficulty? It seems like so many moving targets.

 Brown: Absolutely. There are a lot of moving targets. We’re looking at a situation where organizations are having to put in increasingly complex systems. They’re expected to make them highly available, highly safe, highly secure, and to do so faster and cheaper. That’s kind of tough.

Gardner: One of the ways that organizations have been working towards a solution is to have a standardized approach, perhaps some methodologies, because if all the different elements of their business approach this in a different way, we don’t get too far too quickly, and it can actually be more expensive.

Perhaps you could paint for us the vision of an organization like The Open Group in terms of helping organizations standardize and be a little bit more thoughtful and proactive towards these changed elements?

Brown: With the vision of The Open Group, the headline is “Boundaryless Information Flow.” That was established back in 2002, at a time when organizations were breakingdown the stovepipes or the silos within and between organizations and getting people to work together across functioning. They found, having done that, or having made some progress towards that, that the applications and systems were built for those silos. So how can we provide integrated information for all those people?

As we have moved forward, those boundaryless systems have become bigger

and much more complex. Now, boundarylessness and complexity are giving everyone different types of challenges. Many of the forums or consortia that make up The Open Group are all tackling it from their own perspective, and it’s all coming together very well.

We have got something like the Future Airborne Capability Environment (FACE) Consortium, which is a managed consortium of The Open Group focused on federal aviation. In the federal aviation world they’re dealing with issues like weapons systems.

New weapons

Over time, building similar weapons is going to be more expensive, inflation happens. But the changing nature of warfare is such that you’ve then got a situation where you’ve got to produce new weapons. You have to produce them quickly and you have to produce them inexpensively.

So how can we have standards that make for more plug and play? How can the avionics within a cockpit of whatever airborne vehicle be more interchangeable, so that they can be adapted more quickly and do things faster and at lower cost.

After all, cost is a major pressure on government departments right now.

We’ve also got the challenges of the supply chain. Because of the pressure on costs, it’s critical that large, complex systems are developed using a global supply chain. It’s impossible to do it all domestically at a cost. Given that, countries around the world, including the US and China, are all concerned about what they’re putting into their complex systems that may have tainted or malicious code or counterfeit products.

The Open Group Trusted Technology Forum (OTTF) provides a standard that ensures that, at each stage along the supply chain, we know that what’s going into the products is clean, the process is clean, and what goes to the next link in the chain is clean. And we’re working on an accreditation program all along the way.

We’re also in a world, which when we mention security, everyone is concerned about being attacked, whether it’s cybersecurity or other areas of security, and we’ve got to concern ourselves with all of those as we go along the way.

Our Security Forum is looking at how we build those things out. The big thing about large, complex systems is that they’re large and complex. If something goes wrong, how can you fix it in a prescribed time scale? How can you establish what went wrong quickly and how can you address it quickly?

If you’ve got large, complex systems that fail, it can mean human life, as it did with the BP oil disaster at Deepwater Horizon or with Space Shuttle Challenger. Or it could be financial. In many organizations, when something goes wrong, you end up giving away service.

An example that we might use is at a railway station where, if the barriers don’t work, the only solution may be to open them up and give free access. That could be expensive. And you can use that analogy for many other industries, but how can we avoid that human or financial cost in any of those things?

A couple of years after the Space Shuttle Challenger disaster, a number of criteria were laid down for making sure you had dependable systems, you could assess risk, and you could know that you would mitigate against it.

What The Open Group members are doing is looking at how you can get dependability and assuredness through different systems. Our Security Forum has done a couple of standards that have got a real bearing on this. One is called Dependency Modeling, and you can model out all of the dependencies that you have in any system.

Simple analogy

A very simple analogy is that if you are going on a road trip in a car, you’ve got to have a competent driver, have enough gas in the tank, know where you’re going, have a map, all of those things.

What can go wrong? You can assess the risks. You may run out of gas or you may not know where you’re going, but you can mitigate those risks, and you can also assign accountability. If the gas gauge is going down, it’s the driver’s accountability to check the gauge and make sure that more gas is put in.

We’re trying to get that same sort of thinking through to these large complex systems. What you’re looking at doing, as you develop or evolve large, complex systems, is to build in this accountability and build in understanding of the dependencies, understanding of the assurance cases that you need, and having these ways of identifying anomalies early, preventing anything from failing. If it does fail, you want to minimize the stoppage and, at the same time, minimize the cost and the impact, and more importantly, making sure that that failure never happens again in that system.

The Security Forum has done the Dependency Modeling standard. They have also provided us with the Risk Taxonomy. That’s a separate standard that helps us analyze risk and go through all of the different areas of risk.

Now, the Real-time & Embedded Systems Forum has produced the Dependability through Assuredness, a standard of The Open Group, that brings all of these things together. We’ve had a wonderful international endeavor on this, bringing a lot of work from Japan, working with the folks in the US and other parts of the world. It’s been a unique activity.

Dependability through Assuredness depends upon having two interlocked cycles. The first is a Change Management Cycle that says that, as you look at requirements, you build out the dependencies, you build out the assurance cases for those dependencies, and you update the architecture. Everything has to start with architecture now.

You build in accountability, and accountability, importantly, has to be accepted. You can’t just dictate that someone is accountable. You have to have a negotiation. Then, through ordinary operation, you assess whether there are anomalies that can be detected and fix those anomalies by new requirements that lead to new dependabilities, new assurance cases, new architecture and so on.

The other cycle that’s critical in this, though, is the Failure Response Cycle. If there is a perceived failure or an actual failure, there is understanding of the cause, prevention of it ever happening again, and repair. That goes through the Change Accommodation Cycle as well, to make sure that we update the requirements, the assurance cases, the dependability, the architecture, and the accountability.

So the plan is that with a dependable system through that assuredness, we can manage these large, complex systems much more easily.

Gardner: Allen, many of The Open Group activities have been focused at the enterprise architect or business architect levels. Also with these risk and security issues, you’re focusing at chief information security officers or governance, risk, and compliance (GRC), officials or administrators. It sounds as if the Dependability through Assuredness standard shoots a little higher. Is this something a board-level mentality or leadership should be thinking about, and is this something that reports to them?

Board-level issue

Brown: In an organization, risk is a board-level issue, security has become a board-level issue, and so has organization design and architecture. They’re all up at that level. It’s a matter of the fiscal responsibility of the board to make sure that the organization is sustainable, and to make sure that they’ve taken the right actions to protect their organization in the future, in the event of an attack or a failure in their activities.

The risks to an organization are financial and reputation, and those risks can be very real. So, yes, they should be up there. Interestingly, when we’re looking at areas like business architecture, sometimes that might be part of the IT function, but very often now we’re seeing as reporting through the business lines. Even in governments around the world, the business architects are very often reporting up to business heads.

Gardner: Here in Philadelphia, you’re focused on some industry verticals, finance, government, health. We had a very interesting presentation this morning by Dr. David Nash, who is the Dean of the Jefferson School of Population Health, and he had some very interesting insights about what’s going on in the United States vis-à-vis public policy and healthcare.

One of the things that jumped out at me was, at the end of his presentation, he was saying how important it was to have behavior modification as an element of not only individuals taking better care of themselves, but also how hospitals, providers, and even payers relate across those boundaries of their organization.

That brings me back to this notion that these standards are very powerful and useful, but without getting people to change, they don’t have the impact that they should. So is there an element that you’ve learned and that perhaps we can borrow from Dr. Nash in terms of applying methods that actually provoke change, rather than react to change?

Brown: Yes, change is a challenge for many people. Getting people to change is like taking a horse to water, but will it drink? We’ve got to find methods of doing that.

One of the things about The Open Group standards is that they’re pragmatic and practical standards. We’ve seen’ in many of our standards’ that where they apply to product or service, there is a procurement pull through. So the FACE Consortium, for example, a $30 billion procurement means that this is real and true.

In the case of healthcare, Dr. Nash was talking about the need for boundaryless information sharing across the organizations. This is a major change and it’s a change to the culture of the organizations that are involved. It’s also a change to the consumer, the patient, and the patient advocates.

All of those will change over time. Some of that will be social change, where the change is expected and it’s a social norm. Some of that change will change as people and generations develop. The younger generations are more comfortable with authority that they perceive with the healthcare professionals, and also of modifying the behavior of the professionals.

The great thing about the healthcare service very often is that we have professionals who want to do a number of things. They want to improve the lives of their patients, and they also want to be able to do more with less.

Already a need

There’s already a need. If you want to make any change, you have to create a need, but in healthcare, there is already a pent-up need that people see that they want to change. We can provide them with the tools and the standards that enable it to do that, and standards are critically important, because you are using the same language across everyone.

It’s much easier for people to apply the same standards if they are using the same language, and you get a multiplier effect on the rate of change that you can achieve by using those standards. But I believe that there is this pent-up demand. The need for change is there. If we can provide them with the appropriate usable standards, they will benefit more rapidly.

Gardner: Of course, measuring the progress with the standards approach helps as well. We can determine where we are along the path as either improvements are happening or not happening. It gives you a common way of measuring.

The other thing that was fascinating to me with Dr. Nash’s discussion was that he was almost imploring the IT people in the crowd to come to the rescue. He’s looking for a cavalry and he’d really seemed to feel that IT, the data, the applications, the sharing, the collaboration, and what can happen across various networks, all need to be brought into this.

How do we bring these worlds together? There is this policy, healthcare and population statisticians are doing great academic work, and then there is the whole IT world. Is this something that The Open Group can do — bridge these large, seemingly unrelated worlds?

Brown: At the moment, we have the capability of providing the tools for them to do that and the processes for them to do that. Healthcare is a very complex world with the administrators and the healthcare professionals. You have different grades of those in different places. Each department and each organization has its different culture, and bringing them together is a significant challenge.

In some of that processes, certainly, you start with understanding what it is you’re trying to address. You start with what are the pain points, what are the challenges, what are the blockages, and how can we overcome those blockages? It’s a way of bringing people together in workshops. TOGAF, a standard of The Open Group, has the business scenario method, bringing people together, building business scenarios, and understanding what people’s pain points are.

As long as we can then follow through with the solutions and not disappoint people, there is the opportunity for doing that. The reality is that you have to do that in small areas at a time. We’re not going to take the entire population of the United States and get everyone in the workshop and work altogether.

But you can start in pockets and then generate evangelists, proof points, and successful case studies. The work will then start emanating out to all other areas.

Gardner: It seems too that, with a heightened focus on vertical industries, there are lessons that could be learned in one vertical industry and perhaps applied to another. That also came out in some of the discussions around big data here at the conference.

The financial industry recognized the crucial role that data plays, made investments, and brought the constituencies of domain expertise in finance with the IT domain expertise in data and analysis, and came up with some very impressive results.

Do you see that what has been the case in something like finance is now making its way to healthcare? Is this an enterprise or business architect role that opens up more opportunity for those individuals as business and/or enterprise architects in healthcare? Why don’t we see more enterprise architects in healthcare?

Good folks

Brown: I don’t know. We haven’t run the numbers to see how many there are. There are some very competent enterprise architects within the healthcare industry around the world. We’ve got some good folks there.

The focus of The Open Group for the last couple of decades or so has always been on horizontal standards, standards that are applicable to any industry. Our focus is always about pragmatic standards that can be implemented and touched and felt by end-user consumer organizations.

Now, we’re seeing how we can make those even more pragmatic and relevant by addressing the verticals, but we’re not going to lose the horizontal focus. We’ll be looking at what lessons can be learned and what we can build on. Big data is a great example of the fact that the same kind of approach of gathering the data from different sources, whatever that is, and for mixing it up and being able to analyze it, can be applied anywhere.

The challenge with that, of course, is being able to capture it, store it, analyze it, and make some sense of it. You need the resources, the storage, and the capability of actually doing that. It’s not just a case of, “I’ll go and get some big data today.”

I do believe that there are lessons learned that we can move from one industry to another. I also believe that, since some geographic areas and some countries are ahead of others, there’s also a cascading of knowledge and capability around the world in a given time scale as well.

Gardner: Well great. I’m afraid we’ll have to leave it there. We’ve been talking about the increasingly essential role of standards in a complex world, where risk and dependability become even more essential. We have seen how The Open Group is evolving to meet these challenges through many of its activities and through many of the discussions here at the conference.

Please join me now in thanking our guest, Allen Brown, President and CEO of The Open Group. Thank you.

Brown: Thanks for taking the time to talk to us, Dana.

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